Residual symptoms linked to poor functioning in euthymic bipolar disorder

By Joanna Lyford, Senior medwireNews Reporter

Residual symptoms are associated with functional impairment in euthymic individuals with bipolar disorder, a large observational study has shown.

The finding may support a strategy of targeting residual symptoms with specific therapeutic interventions, say the study authors writing in the Journal of Affective Disorders.

In the OPTHYMUM study, Ludovic Samalin (Centre Hospitalier et Universitaire, Clermont-Ferrand, France) and team recruited 525 adults with bipolar disorder from outpatient departments across France.

Patients were euthymic at enrolment and had not experienced an acute mood episode for at least 6 months. Their mean age was 47.8 years, 39.8% were male, 59.0% had bipolar I disorder, nearly all were receiving pharmacological treatment and around half were in ongoing psychotherapy.

Using a Global Assessment of Functioning score cutoff of 60, as recommended by DSM-IV, the researchers classified 35 patients as having a low functional status and the remainder as having normal functioning.

Comparison of these two groups revealed differences in clinical course, symptoms and treatment. For instance, low-functioning patients were more likely than others to have a manic-predominant polarity, to have experienced psychotic symptoms and to have a history of addiction and hospitalisation.

Patients with low functioning were also more likely to be taking second-generation antipsychotics and benzodiazepines and less likely to be taking anticonvulsants or to be in psychotherapy compared with normal-functioning patients.

Low-functioning patients had significantly lower scores on the Multidimensional Assessment of Thymic States instrument, at 96.7 versus 102.2, indicating general inhibition, as well as a higher degree of “morningness” and more sexual dysfunction.

Finally, patients with low functional status reported more cognitive and stigma complaints, including greater social and family stigmatisation, more emotional lability, more emotional anaesthesia and greater impairment of planning ability and psychomotor retardation.

Taken together, these results indicate that functional status is associated with many aspects of life in euthymic individuals with bipolar disorder. “In particular, residual symptoms were observed more frequently in euthymic patients with low functioning,” write Samalin and co-authors.

“Several aspects of the so called ‘residual symptoms’ (depressive or manic subsyndromal symptoms, disruption of circadian rhythms, perceived cognitive dysfunction, sexual dysfunction…) are associated with functional impairment and may represent specific treatment targets,” they remark.

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